Effect of concomitant use of clopidogrel and proton pump inhibitors after percutaneous coronary intervention

Subhash Banerjee, Rick A. Weideman, Mark W. Weideman, Bertis B. Little, Kevin C. Kelly, Jennifer T. Gunter, Kathryn L. Tortorice, Michelle Shank, Byron L Cryer, Robert F Reilly, Sunil V. Rao, Adnan Kastrati, James A de Lemos, Emmanouil S Brilakis, Deepak L. Bhatt

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

The aim of the present study was to analyze the effect of drug exposure patterns of clopidogrel and proton pump inhibitors (PPIs) on the clinical outcomes after percutaneous coronary intervention (PCI). Previous analyses predominantly included discharge medications and did not explore the effect of the drug exposure patterns. We analyzed all-cause death, nonfatal myocardial infarction, repeat revascularization, and major adverse cardiovascular events (MACE) in a cohort of 23,200 post-PCI patients (January 2003 to December 2008) using a multivariate adjusted Cox model and propensity-matched case-control analysis. The adjusted hazard ratio for MACE on PPI according to the exposure patterns of clopidogrel after PCI for 6 years was 1.24 (95% confidence interval [CI] 1.11 to 1.38) and 1.12 (95% CI 1.03 to 1.22) for "continuous" (consistent clopidogrel with or without PPIs) and "switched" (clopidogrel with or without varying PPIs) respectively. However, the propensity score adjusted odds ratios for MACE on PPI use was 0.97 (95% CI 0.65 to 1.44) for "continuous" and 1.04 (95% CI 0.87 to 1.25) for "switched." Moreover, in the first year after PCI, the use of "rescue" (≤30 days before MACE) nitroglycerin was greater in the patients taking clopidogrel and PPIs than in those taking clopidogrel alone, as was the overall use of rescue PPIs (p <0.001). In conclusion, PPI use in clopidogrel-treated post-PCI patients was not associated with an increased risk of MACE after controlling for the confounding effect of PPI use with propensity matching. A potential for the misdiagnosis of angina symptoms and rescue use of nitroglycerin and PPIs in post-PCI patients exists, a finding that might have confounded previous observational analyses.

Original languageEnglish (US)
Pages (from-to)871-878
Number of pages8
JournalAmerican Journal of Cardiology
Volume107
Issue number6
DOIs
StatePublished - Mar 15 2011

Fingerprint

clopidogrel
Proton Pump Inhibitors
Percutaneous Coronary Intervention
Confidence Intervals
Nitroglycerin
Propensity Score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of concomitant use of clopidogrel and proton pump inhibitors after percutaneous coronary intervention. / Banerjee, Subhash; Weideman, Rick A.; Weideman, Mark W.; Little, Bertis B.; Kelly, Kevin C.; Gunter, Jennifer T.; Tortorice, Kathryn L.; Shank, Michelle; Cryer, Byron L; Reilly, Robert F; Rao, Sunil V.; Kastrati, Adnan; de Lemos, James A; Brilakis, Emmanouil S; Bhatt, Deepak L.

In: American Journal of Cardiology, Vol. 107, No. 6, 15.03.2011, p. 871-878.

Research output: Contribution to journalArticle

Banerjee, S, Weideman, RA, Weideman, MW, Little, BB, Kelly, KC, Gunter, JT, Tortorice, KL, Shank, M, Cryer, BL, Reilly, RF, Rao, SV, Kastrati, A, de Lemos, JA, Brilakis, ES & Bhatt, DL 2011, 'Effect of concomitant use of clopidogrel and proton pump inhibitors after percutaneous coronary intervention', American Journal of Cardiology, vol. 107, no. 6, pp. 871-878. https://doi.org/10.1016/j.amjcard.2010.10.073
Banerjee, Subhash ; Weideman, Rick A. ; Weideman, Mark W. ; Little, Bertis B. ; Kelly, Kevin C. ; Gunter, Jennifer T. ; Tortorice, Kathryn L. ; Shank, Michelle ; Cryer, Byron L ; Reilly, Robert F ; Rao, Sunil V. ; Kastrati, Adnan ; de Lemos, James A ; Brilakis, Emmanouil S ; Bhatt, Deepak L. / Effect of concomitant use of clopidogrel and proton pump inhibitors after percutaneous coronary intervention. In: American Journal of Cardiology. 2011 ; Vol. 107, No. 6. pp. 871-878.
@article{ef03c5edccd54f3f8be9cc2a392c2768,
title = "Effect of concomitant use of clopidogrel and proton pump inhibitors after percutaneous coronary intervention",
abstract = "The aim of the present study was to analyze the effect of drug exposure patterns of clopidogrel and proton pump inhibitors (PPIs) on the clinical outcomes after percutaneous coronary intervention (PCI). Previous analyses predominantly included discharge medications and did not explore the effect of the drug exposure patterns. We analyzed all-cause death, nonfatal myocardial infarction, repeat revascularization, and major adverse cardiovascular events (MACE) in a cohort of 23,200 post-PCI patients (January 2003 to December 2008) using a multivariate adjusted Cox model and propensity-matched case-control analysis. The adjusted hazard ratio for MACE on PPI according to the exposure patterns of clopidogrel after PCI for 6 years was 1.24 (95{\%} confidence interval [CI] 1.11 to 1.38) and 1.12 (95{\%} CI 1.03 to 1.22) for {"}continuous{"} (consistent clopidogrel with or without PPIs) and {"}switched{"} (clopidogrel with or without varying PPIs) respectively. However, the propensity score adjusted odds ratios for MACE on PPI use was 0.97 (95{\%} CI 0.65 to 1.44) for {"}continuous{"} and 1.04 (95{\%} CI 0.87 to 1.25) for {"}switched.{"} Moreover, in the first year after PCI, the use of {"}rescue{"} (≤30 days before MACE) nitroglycerin was greater in the patients taking clopidogrel and PPIs than in those taking clopidogrel alone, as was the overall use of rescue PPIs (p <0.001). In conclusion, PPI use in clopidogrel-treated post-PCI patients was not associated with an increased risk of MACE after controlling for the confounding effect of PPI use with propensity matching. A potential for the misdiagnosis of angina symptoms and rescue use of nitroglycerin and PPIs in post-PCI patients exists, a finding that might have confounded previous observational analyses.",
author = "Subhash Banerjee and Weideman, {Rick A.} and Weideman, {Mark W.} and Little, {Bertis B.} and Kelly, {Kevin C.} and Gunter, {Jennifer T.} and Tortorice, {Kathryn L.} and Michelle Shank and Cryer, {Byron L} and Reilly, {Robert F} and Rao, {Sunil V.} and Adnan Kastrati and {de Lemos}, {James A} and Brilakis, {Emmanouil S} and Bhatt, {Deepak L.}",
year = "2011",
month = "3",
day = "15",
doi = "10.1016/j.amjcard.2010.10.073",
language = "English (US)",
volume = "107",
pages = "871--878",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Effect of concomitant use of clopidogrel and proton pump inhibitors after percutaneous coronary intervention

AU - Banerjee, Subhash

AU - Weideman, Rick A.

AU - Weideman, Mark W.

AU - Little, Bertis B.

AU - Kelly, Kevin C.

AU - Gunter, Jennifer T.

AU - Tortorice, Kathryn L.

AU - Shank, Michelle

AU - Cryer, Byron L

AU - Reilly, Robert F

AU - Rao, Sunil V.

AU - Kastrati, Adnan

AU - de Lemos, James A

AU - Brilakis, Emmanouil S

AU - Bhatt, Deepak L.

PY - 2011/3/15

Y1 - 2011/3/15

N2 - The aim of the present study was to analyze the effect of drug exposure patterns of clopidogrel and proton pump inhibitors (PPIs) on the clinical outcomes after percutaneous coronary intervention (PCI). Previous analyses predominantly included discharge medications and did not explore the effect of the drug exposure patterns. We analyzed all-cause death, nonfatal myocardial infarction, repeat revascularization, and major adverse cardiovascular events (MACE) in a cohort of 23,200 post-PCI patients (January 2003 to December 2008) using a multivariate adjusted Cox model and propensity-matched case-control analysis. The adjusted hazard ratio for MACE on PPI according to the exposure patterns of clopidogrel after PCI for 6 years was 1.24 (95% confidence interval [CI] 1.11 to 1.38) and 1.12 (95% CI 1.03 to 1.22) for "continuous" (consistent clopidogrel with or without PPIs) and "switched" (clopidogrel with or without varying PPIs) respectively. However, the propensity score adjusted odds ratios for MACE on PPI use was 0.97 (95% CI 0.65 to 1.44) for "continuous" and 1.04 (95% CI 0.87 to 1.25) for "switched." Moreover, in the first year after PCI, the use of "rescue" (≤30 days before MACE) nitroglycerin was greater in the patients taking clopidogrel and PPIs than in those taking clopidogrel alone, as was the overall use of rescue PPIs (p <0.001). In conclusion, PPI use in clopidogrel-treated post-PCI patients was not associated with an increased risk of MACE after controlling for the confounding effect of PPI use with propensity matching. A potential for the misdiagnosis of angina symptoms and rescue use of nitroglycerin and PPIs in post-PCI patients exists, a finding that might have confounded previous observational analyses.

AB - The aim of the present study was to analyze the effect of drug exposure patterns of clopidogrel and proton pump inhibitors (PPIs) on the clinical outcomes after percutaneous coronary intervention (PCI). Previous analyses predominantly included discharge medications and did not explore the effect of the drug exposure patterns. We analyzed all-cause death, nonfatal myocardial infarction, repeat revascularization, and major adverse cardiovascular events (MACE) in a cohort of 23,200 post-PCI patients (January 2003 to December 2008) using a multivariate adjusted Cox model and propensity-matched case-control analysis. The adjusted hazard ratio for MACE on PPI according to the exposure patterns of clopidogrel after PCI for 6 years was 1.24 (95% confidence interval [CI] 1.11 to 1.38) and 1.12 (95% CI 1.03 to 1.22) for "continuous" (consistent clopidogrel with or without PPIs) and "switched" (clopidogrel with or without varying PPIs) respectively. However, the propensity score adjusted odds ratios for MACE on PPI use was 0.97 (95% CI 0.65 to 1.44) for "continuous" and 1.04 (95% CI 0.87 to 1.25) for "switched." Moreover, in the first year after PCI, the use of "rescue" (≤30 days before MACE) nitroglycerin was greater in the patients taking clopidogrel and PPIs than in those taking clopidogrel alone, as was the overall use of rescue PPIs (p <0.001). In conclusion, PPI use in clopidogrel-treated post-PCI patients was not associated with an increased risk of MACE after controlling for the confounding effect of PPI use with propensity matching. A potential for the misdiagnosis of angina symptoms and rescue use of nitroglycerin and PPIs in post-PCI patients exists, a finding that might have confounded previous observational analyses.

UR - http://www.scopus.com/inward/record.url?scp=79952312041&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952312041&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2010.10.073

DO - 10.1016/j.amjcard.2010.10.073

M3 - Article

C2 - 21247527

AN - SCOPUS:79952312041

VL - 107

SP - 871

EP - 878

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 6

ER -